Dry Mouth

Overview

One of the biggest problems facing dentists and patients today is “dry mouth” (or xerostomia). Dry mouth occurs when saliva flow in the mouth is seriously diminished, leading to an increase in dental disease. One of the most common causes of dry mouth is the more than 1,200 commonly prescribed medicines that decrease saliva flow as a side effect. As baby boomers age and are prescribed medications with this side effect, their dental problems can become compounded (especially if they were born and raised in a community that didn’t fluoridate water when their teeth are developing).

Signs and symptoms

Dry mouth can occur as a result of taking medications, or from nervousness, stress, or other emotional upset. This is a normal body function, usually short-term and does not lead to any long-term problems with the mouth. Long-term cases of dry mouth will lead to sore, irritated oral soft tissue and an increased susceptibility to tooth decay, periodontal disease and other infections. As saliva decreases, the number of bacteria in the mouth increases.

Common symptoms include a dry, pasty feeling when you open or close your mouth; difficulty while chewing, swallowing, or speaking; an ongoing burning sensation; and/or a frequent need to sip water.

Patients who wear full dentures and suffer with dry mouth are less likely to be comfortable because saliva helps dentures adhere properly. Dry mouth can also result in painful denture sore spots, dry and cracked lips, and an overall increased risk of oral infection.

Common causes of dry mouth

Dry mouth was once considered a common symptom of aging; today, however, we associate it with certain prescribed medications and medical conditions. Some of these medical conditions include: radiation therapy for treatment of cancers to the head and neck (which can produce significant damage to the saliva glands), HIV/AIDS, Alzheimer’s, anemia, rheumatoid arthritis, diabetes, Parkinson’s disease, and cystic fibrosis, to name a few.

The main function of saliva

  1. Lubrication and binding: The mucus in saliva works in binding food that has been chewed so it can be swallowed without inflicting damage to the soft tissue lining of the throat. Saliva coats the mouth and throat so the food does not directly touch the epithelial cells of those tissues.
  2. Softens dry food: In order for food to be tasted, food must be dissolved and flavor released.
  3. Oral hygiene: The mouth is almost constantly flushed with saliva, which floats away food debris and keeps it relatively clean. The flow of saliva diminishes considerably during sleep, allowing populations of bacteria to build.
  4. Recalcification: As the acid-producing bacteria begin the process of tooth decay, ions in the saliva help to recalcify damaged enamel.

The main components of saliva include:

  • Water
  • Electrolytes:
    • Sodium
    • Potassium
    • Calcium
    •  Magnesium
    • Chloride
    • Bicarbonate
    •  Phosphate
    • Iodine
  • Mucus
  • Enzymes:
    • Amylase: starts the digestion of starch prior to swallowing
    • Lipase: starts the digestion of fat prior to swallowing
  • Anti-microbial enzymes that kill bacteria
  • Praline-rich proteins (helps in enamel formation, microbe killing, and lubrication)

Relieve dry mouth and protect yourself against an increase in disease

The best suggestions for dry mouth relief are:

  • Taking Over-the-Counter medications that help offset decreased saliva flow
  •  Mouthwashes that help offset decreased saliva flow
  • Increasing fluid intake
  • Chewing sugarless gum containing Xylitol
  • Sucking on ice chips
  • Breathing through your nose instead of your mouth
  • Regular moisturizing of lips
  • Sleeping with a humidifier

The best suggestions to protect you against an increase in tooth and gum disease:

  • Regular checkups for evaluation and treatment as a preventative measure.
  • Regular brushing and flossing.
  • Avoid salty foods.
  • Avoid dry food (crackers and chips).
  • Limiting sugar intake: limit sugar intake to after meals, as this is the time when you have the greatest saliva flow.
  • Avoid tobacco (most chewing tobacco contains sugar).
  • Avoid alcohol, caffeine, and carbonated beverages; all these decrease saliva production

Always carry a list of all your medications with you and supply this information to your dentist, who will review this list with you and discuss the associated conditions for which the medications have been prescribed. In some cases, a different drug can be provided or your dosage modified to help reduce or alleviate symptoms. Your regular doctor will often tell you if the drug they are prescribing will cause dry mouth, but rarely will explain the long term dental health consequences. Your dentist and pharmacist are your most reliable sources to help you deal with this problem.

Common medications causing dry mouth

There are well over a thousand medications that cause dry mouth. They include, but are not limited to:

  • Antidepressants
  • High blood pressure medications
  • Heart medications
  • Antihistamines
  • Decongestants
  • Iron supplements
  • Narcotic analgesics
  • Hormone replacement therapy